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Biomedical subjects

S Falcone

Publications and source records attributed to S Falcone.

At least 19 recordsLinked to original sources

Emotional activation of obese and normal women due to imagery and food content of verbal stimuli in a memory task.

The aim of this study is to look for correlation between a physiological variable (skin conductance, SCL) and cognitive variables (reaction time, RT and productivity score) obtained in a memory task. Subjects were 17 females, including 7 patients and 10 controls. Patients were recruited among women who went to a clinic for alimentary disorders because of obesity and volunteered for this study; controls were normal women of comparable age without any alimentary problem. Tonic variations of SCL were recorded by a computerized polygraph during the execution of the cognitive task, which consisted of a computerized presentation of frequent, everyday used words evenly divided according to an alimentary/nonalimentary content and to a high/low imagery quality. The acquisition session was followed by an immediate recognition session where subjects were asked to identify the previously presented words among an equal number of similar words not included in the acquisition list. The two session series (acquisition and recognition) were repeated three times to evaluate the learning curve and habituation. This same procedure was separately performed with high imagery alimentary/nonalimentary words and with another list of low imagery alimentary/nonalimentary words. During the recognition tasks, both RT and productivity scores were recorded. A correlation analysis between cognitive and physiological variables was carried out to explore how subjects with different attitudes to food react in cognitive and somatic terms when exposed to verbal stimuli concerning this topic and to neutral verbal stimuli. Results show that obese patients have a different emotional activation in front of these verbal stimuli where both the cognitive activity and the somatic responses are affected by their involvement with the verbal stimuli. On the contrary, the imagery effect does not seem to be influenced by the content and by the idiosyncratic reactions to it of the specific groups of subjects.

Adult↗

Reduction of risk factors for cardiovascular diseases in morbid-obese patients following biliary-intestinal bypass: 3 years' follow-up.

BACKGROUND: Obese patients are often affected by hypertension, dyslipidaemia, impaired glucose metabolism, and suffer from cardiovascular disease (CVD), related to the characteristic metabolic alterations. AIM OF THE STUDY: To evaluate reduction of risk factors for CVDs in morbid-obese patients (body mass index (BMI)>40 kg/m2) after weight loss upon bariatric surgery intervention of biliary-intestinal bypass. SUBJECTS: 45 (17 men, 28 women) morbid-obese patients (age: 19-49 y, BMI>40 kg/m2). All patients were selected on the basis of medical history, physical and biochemical evaluation and of psychiatric tests, which were performed on all individuals admitted to our Day Hospital to verify the safety of surgical intervention. MEASUREMENTS: Body weight, body composition (by dual X-ray absorptiometry, DXA), blood pressure, lipid profile, fibrinogen and glucose metabolism were monitored at baseline and 1, 3, 6, 9, 12, 24 and 36 months after surgery. RESULTS: A significant and persistent weight loss was present in all patients at the end of the 3 y follow-up period (P<0.001), with a progressive reduction of total and trunk fat mass as evaluated by means of DXA. Additionally, a parallel significant reduction in systolic (P<0.001) and diastolic (P<0.001) blood pressure was observed. Total and LDL cholesterol were significantly reduced (P<0.001), while HDL showed no modifications; triglycerides declined progressively during the 3 y follow-up (P<0.001). Fibrinogen decreased from 364.5+/-82.4 to 266.4+/-45.7 mg/dl at the end of the period (P<0.001). Fasting glucose levels and glucose levels 120 min after an oral glucose tolerance test were reduced from 95.1+/-20.3 to 78.6+/-9.1 mg/dl (P<0.001) and from 116.9+/-34.7 to 77.6+/-15.5 mg/dl (P<0.001), respectively, at baseline and at the end of the study. Moreover, fasting insulin decreased from 30.0+/-20.4 to 8.6+/-2.9 microUI/ml (P<0.001) after 3 y, while insulin levels after (120 min) oral glucose load decreased from 105.5+/-61.5 to 12.0+/-6.0 microUI/ml (P<0.001). CONCLUSION: Our results show that biliary-intestinal bypass may represent a valid and alternative therapeutic approach in patients with morbid obesity since it induces a significant and stable reduction of body weight and obesity-related risk factors for CVD.

Adult↗

Term angular pregnancy with placenta accreta. A case report.

A 27-year-old primigravida, with two prior adnexal operations, had retained placenta with postpartum haemorrhage following an uncomplicated vaginal delivery. Laparotomic removal revealed placental accretism. Pharmacological treatment (oxytocin and sulprostone) and right cornual resection failed to control profuse bleeding. In the end, subtotal hysterectomy was unavoidable.

Adult↗

The orexigram in patients affected by morbid obesity: a preliminary report on daily hunger sensation before bariatric surgery.

OBJECTIVE: The present study investigated the orexigram, the time-qualified self-rated estimate of hunger sensation (HS), in patients affected by morbid obesity (MO) with the aim of detecting how daily HS behaves before morbidly obese patients (MOP) undergo bariatric surgery (BS). This article is therefore a preliminary report as it is necessary to make subsequent comparisons with post-BS orexigrams. Preoperative orexigrams may be helpful in selecting the MOPs who are candidates for surgical treatment. MATERIALS AND METHODS: Ten MOPs (five males and five females, with a mean age of 34 +/- 11 yr and a mean BMI of 49.32 +/- 7.26 kg/m2), and 19 clinically healthy control subjects (CHS: nine males and ten females, with a mean age of 24 +/- 2 yr and a mean BMI of 21.00 +/- 1.70 kg/m2) gave their informed consent to participate in the study. All of the study participants were asked to compile a 24-h orexigram, which was then biometrically analysed by means of: 1) conventional methods for parametric statistics; 2) rhythm analysis for their circadian rhythms; and 3) spectral analysis for their harmonic structure. RESULTS: The orexigrams of the MOPs had significantly increased mean daily levels (daily hyperorexia), retained their circadian periodicity despite an increase in mesor, and were consistently modified in their ultradian spectral harmonic components. CONCLUSIONS: The results show that the studied MOPs complain of a daily hyperorexia that is still perceived circadically. This perception is a structured abnormality, as demonstrated by the consistent changes in the spectral analysis, and so MOPs can be diagnosed as being affected by so-called "hyperorectic obesity". It will be interesting to see whether or not presurgical hyperorexia in MOPs is corrected by BS: if so, hyperorexia may become an additional indication, and presurgery orexigrams could be suggested as an additional means of selecting the hyperorectic MOPs who are candidates for surgical treatment.

Adult↗

Adrenocortical carcinoma with cerebral metastasis in a child: case report and review of the literature.

OBJECTIVE AND IMPORTANCE: Adrenocortical carcinoma (ACC) is rare in the pediatric population, and brain metastasis seldom occurs. CLINICAL PRESENTATION: The authors report a case of metastatic ACC to the brain in a 9-year-old patient who had an adrenal cortex neoplasm removed at 4 years of age, and was free of symptoms for 5 years. Two weeks before admission she complained of blurred vision in both eyes. INTERVENTION: Examination revealed bilateral papilledema, and a Magnetic Resonance Imaging (MRI) of the brain revealed a mass in the left lateral ventricle with extensive vasogenic edema and hydrocephalus. The tumor was removed, and histopathologic examination demonstrated metastatic ACC. CONCLUSION: Although ACC is a rare neoplasm it must be considered in the differential diagnosis of cerebral lesions in patients with a history of this tumor. Periodic long-term brain imaging is suggested as part of the follow up in patients with adrenocortical neoplasms.

Adrenal Cortex Neoplasms↗

Encephalitis, cerebritis, and brain abscess: pathophysiology and imaging findings.

This article discusses the imaging findings of encephalitis, cerebritis, and brain abscess in immunocompetent patients. MR imaging is the procedure of choice in evaluating suspected intracranial infections because of its inherent contrast resolution, multiplanar capability, improved sensitivity in the posterior fossa, sensitivity to the presence of subacute, and chronic hemorrhage, and its sensitivity to the detection of meningeal disease on postcontrast images. Discussion of pathologic conditions and imaging features of encephalitis are based on the most common causative agents of each type of disease. Imaging features and pathologic conditions of cerebritis and brain abscesses also are reviewed with emphasis on pyogenic bacteria.

Brain↗

CT-revealed choroidal effusions as a sign of carotid cavernous fistula.

Choroidal effusions may appear as subtle abnormalities on CT scans. Recognition of choroidal effusions, however, is critical because they may be an early sign of ocular pathologic abnormality. After detection, the various causes of choroidal effusions, such as carotid cavernous fistulas, ocular hypotony, tumors, and inflammatory conditions, should be considered.

Aged↗

Walker-Warburg syndrome: neurologic features and muscle membrane structure.

Walker-Warburg syndrome is an autosomal-recessive genetic disorder characterized by congenital muscular dystrophy in association with complex developmental abnormalities of the central nervous system and the eyes. Two patients with Walker-Warburg syndrome are presented to demonstrate clinical variability. Previously unreported pathologic findings involving heart, muscle, spinal cord, and gall bladder are described, and the literature is reviewed. Histopathologic studies of the muscle membrane protein network in both Walker-Warburg syndrome patients reveal a decreased immunostaining for laminin alpha2 and beta-dystroglycan. The clinical, histologic, and biochemical variability in Walker-Warburg patients may reflect heterogeneity.

Brain↗

Lack of normal MR enhancement of the pituitary gland: findings in three siblings with combined pituitary hormone deficiency.

We present the MR appearance of the sella turcica in three sibling dwarfs with combined pituitary hormone deficiency in which MR images revealed a peripheral curvilinear band of enhancement about the pituitary gland in all three patients, a normal-size pituitary gland in two siblings, a mildly enlarged pituitary gland in one sibling, and a thin infundibulum and a normal posterior pituitary bright spot in all three siblings. Possible antecedents include an abnormal vascular supply, pituitary gland replacement by a nonfunctioning adenoma, a proteinaceous cyst, or a hamartoma.

Adolescent↗

Enhancing meningeal blood vessels masquerading as leptomeningeal spread of tumor in obstructive hydrocephalus.

MR showed an enhancing mass in the pineal region and hydrocephalus and leptomeningeal enhancement, thought to indicate pinealoblastoma with leptomeningeal spread. During resection there was no evidence of spread, and repeat MR showed no residual tumor or meningeal enhancement, so the patient was not treated for metastasis. Because there were no signs of leptomeningeal tumor 4 months after surgery, the meningeal enhancement is thought to have been related to venous stasis secondary to obstructive hydrocephalus.

Brain Neoplasms↗

MR of omental myelosynangiosis.

PURPOSE: To describe MR findings in patients who have undergone omental transposition (omental myelosynangiosis) for spinal cord revascularization. METHODS: Spin-echo MR images, without and with intravenous gadolinium, were obtained before and after surgery in three patients using a quadrature spine coil. Three-dimensional time-of-flight spinal MR angiography was also performed. RESULTS: On routine MR, the transposed omentum is an irregular, lobulated fat-equivalent mass, containing serpiginous areas of flow void, which extends through the laminectomy site to lie directly adjacent to the cord surface. MR angiography demonstrated small omental vessels, some coursing to the omentum-cord interface; however, no definite extension into the cord was detected. In all patients, there was alteration in cord size and contour after transposition, but no change in cord signal. Clinical improvement was observed in one of the three patients. The signal characteristics of the transposed omentum changed, showing less homogeneity and a gradual loss of the signal over a period of 4 months. CONCLUSIONS: MR delineates transposed omentum and associated postoperative changes in omental myelosynangiosis. MR angiography is useful as an adjunct to demonstrate the small vessels near the omentum-cord interface, but lacks sufficient resolution to demonstrate neoangiogenesis within the cord.

Adult↗

Imaging in acute basilar artery thrombosis.

The aim of this study was to review the imaging features in acute (< 24 h) basilar artery thrombosis. CT and MR studies in 11 patients with clinical diagnosis of acute basilar artery thrombosis were retrospectively reviewed. MR angiography was obtained in 4 patients. Correlation with clinical symptoms was performed. Multiple cranial nerve palsies and hemiparesis were the most common clinical symptoms at presentation. CT revealed hyperdense basilar arteries (n = 7) and hypodensities in the posterior circulation territory (n = 8). In one instance, the infarction was hemorrhagic. MR imaging showed absence of flow void within the basilar in 6 patients and MRA (using both PC and TOF techniques) confirmed absence of blood flow in 4 basilar arteries. One week after presentation, 5 patients died. Autopsy was obtained in 1 case and confirmed the diagnosis of basilar artery thrombosis. Basilar artery thrombosis has fairly typical imaging features by both CT and MR. MRA may be used to confirm the diagnosis. Prompt recognition may lead to early thrombolytic treatment and may improve survival.

Acute Disease↗

Orbital venous approach to the cavernous sinus: an analysis of the facial and orbital venous system.

Carotid-cavernous fistulas are abnormal communications between the internal carotid artery and the cavernous sinus produced by a rupture of the wall of the carotid artery or one of its branches into the sinus. Extradural branches of the internal or external carotid arteries may communicate with the cavernous sinus, producing proptosis, progressive glaucoma, and ocular vascular engorgement. Various approaches to obliterate these fistulas have evolved, many of which carry high morbidity or are precluded by anatomical considerations. Analysis of the venous anatomy of the orbit and face, including human cadaver dissections, reveals a new and safe approach to the cavernous sinus, requiring microsurgical isolation and cannulation of the superior ophthalmic vein through an anterior orbital approach. Selective embolization of a carotid-cavernous fistula can be performed successfully through this route. We present pertinent anatomy and technical considerations and the successful clinical application of these principles. Surgeons familiar with craniofacial anatomy and microvascular techniques can apply these principles and play an active role in the treatment of these complex problems.

Aged↗

Progressive posttraumatic myelomalacic myelopathy: imaging and clinical features.

PURPOSE: To describe the imaging features, surgical management, and clinical outcome of progressive posttraumatic myelomalacic myelopathy (PPMM), a relatively unrecognized but important cause of progressive myelopathy in patients with previous spinal cord injuries. METHODS: The clinical records, imaging studies, and postoperative outcome of 10 patients with PPMM were reviewed. Fifteen preoperative and five postoperative MRs were analyzed for intramedullary signal abnormalities, the nature of these signal abnormalities, and cord tethering. All patients had intraoperative sonography. RESULTS: Neurologic signs and symptoms found in our patients included 1) progressive loss of motor function (6/10), 2) sensory level changes (4/10), 3) increased spasticity (4/10), 4) autonomic dysreflexia (4/10), 5) loss of bowel or bladder control (4/10), and 6) local and/or radicular pain (4/10). Preoperative MR in nine patients revealed intramedullary T1/T2 lengthening (9/9), extramedullary tethering/adhesions (9/9), ill-defined lesional borders (6/9), cord expansion (5/9), and increased signal intensity of the lesion on T1-weighted images compared with CSF (7/9). Proton density images in five patients demonstrated a relative increase in signal intensity over CSF. In all five postoperative MRs, there was evidence of untethering of the spinal cord and a decrease in cord size in two patients. Intraoperative sonography revealed cord tethering and abnormal cord echotexture in all cases. Postoperative clinical evaluation revealed neurologic improvement in nine patients. CONCLUSIONS: PPMM may clinically and radiographically mimic progressive posttraumatic cystic myelopathy (PPCM). MR provides clues to the diagnosis of myelomalacia preoperatively. Intraoperative sonography confirms the absence of a confluent cyst. These points are crucial in the surgical procedures in PPMM vs PPCM. In PPMM, lysis of intradural adhesions results in an improvement in symptoms in a manner similar to the shunting of PPCM.

Adult↗

Magnetic resonance imaging of unusual intracranial infections.

We review the etiologic agents, epidemiology, pathogenesis, pathology, clinical manifestations, and imaging features of several unusual intracranial infections that have not been discussed elsewhere in this issue. The central nervous system (CNS) infections discussed are Creutzfeldt-Jakob disease (CrJaD), neurosyphilis, primary amebic meningoencephalitis (PAM), granulomatous amebic encephalitis (GAE), cerebral amebiasis, and cerebral hydatid disease.

Brain↗

Gastric manifestations of AIDS: radiographic findings on upper gastrointestinal examination.

The radiographic findings in the stomach in the upper gastrointestinal examination in 11 patients with the Acquired Immune Deficiency Syndrome (AIDS) were reviewed. Four cases of Kaposi's sarcoma (KS) showed multiple submucosal nodular filling defects; in one of these cases, ulceration of some of the nodules was present. Gastric lymphoma occurred in two cases and appeared as one or several large nodular masses; one of these involved the esophagogastric junction. Five cases of infectious gastritis, caused by cytomegalovirus (CMV), Cryptosporidium, and Toxoplasma, were manifested as thickened gastric folds and/or antral narrowing. Thus, in patients with AIDS, gastric neoplastic lesions can be suggested when nodular filling defects or masses are identified, whereas inflammatory processes tend to show thickened gastric folds or antral narrowing. However, endoscopic biopsy is required to enable proper treatment.

Acquired Immunodeficiency Syndrome↗